What should be done about America’s obesity problem? It all depends on where you put the blame

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Less than two decades ago, in the early 1990s, only 2 to 3 percent of Americans considered obesity to be a major health problem.

Then along came the 2001 publication of the U.S. Surgeon General’s report on the obesity “epidemic” as well as a slew of related studies and reports, and the percentage of Americans for whom obesity became a major health issue skyrocketed — to 67 percent by 2006.

A study published Monday by the journal Health Affairs will undoubtedly raise that percentage even higher. It found that the medical costs of an obese person averages $1,400 more each year than for someone of normal weight. That’s roughly 42 percent higher.

Overall, obesity-related health spending has doubled from what it was a decade ago — to an annual cost of $147 billion. That’s 9.1 percent of all medical spending in the United States, up from 6.5 percent a decade ago. The money is mostly spent not on helping people reduce their weight, but on chronic conditions that are more common among the overweight, such as diabetes and heart disease, the study reported. The leading driver of those excess costs: prescription drugs.

What to do about it?
The numbers from this study, along with the somber fact that two-thirds of Americans are now either overweight or obese, will undoubtedly feed the current debate over the rising cost of medicine and, more importantly, what we should do about it.

But what should we do about the obesity part of it?

On Monday, Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, outlined his ideas at his agency’s first conference on obesity prevention and control.

Wrote Lauren Neergaard, who covered the speech for the Associated Press:

It’s not an individual problem but a societal problem — as the nation’s health bill illustrates — that will take society-wide efforts to reverse, Frieden stressed. His agency last week released a list of strategies it wants communities to try. They include: increasing healthy foods and drinks in schools and other public venues; building more supermarkets in poor neighborhoods; encouraging more mothers to breast-feed, which protects against childhood obesity; and discouraging consumption of sodas and other sweetened beverages. … He said there’s some evidence that adding a tax to those drinks might help curb consumption.

Whether the public will go along with those strategies remains to be seen. But according to intriguing research published by the Yale School of Public Health earlier this year, much will depend on what we perceive (or are told) are the causes of America’s growing weight problem.

Blaming
The Yale study found that an individual’s personal beliefs about why people become obese help predict which public policies that person will support to fix the problem.

For example, if you agree with Frieden and view obesity mostly as the consequence of external, societal factors out of an individual’s control — such as the lack of healthful, affordable food in certain neighborhoods — you’re likely to support government efforts to devise new policies and programs that address those factors.

But if you see obesity as a matter of personal responsibility and liken it to other “bad” or “sinful” behaviors (say, sloth and gluttony), you’re less likely to back public anti-obesity policies — except for supporting a policy that would require people who are overweight or who refuse to exercise to pay higher health-insurance premiums.

Interestingly, the study found that political ideology (conservative, moderate, liberal, Republican, Democrat, Independent) was not a key predictor of whether people would support government intervention to combat obesity — except when it came to policies that increased taxes.

Another surprise was that people’s own personal health status, including whether they were themselves overweight or obese, failed to play much of a role in their support or nonsupport of various obesity policies.

Framing
So, how we tackle the rising costs and health dangers of obesity may depend, as it does with so many other issues, on how the problem is framed. Here’s the Yale researchers’ description of the two most probable framing approaches:

For obesity prevention advocates, framing obesity using low-blame metaphors (e.g., obesity as the product of industry manipulation, an increasingly toxic food environment) may be the most effective strategy for increasing support for public policy. Likewise, highlighting the metaphor of sinful behavior by linking the concepts of sloth, gluttony, and individual responsibility may be the best approach for those interested in either blocking policy action or enacting more punitive policies.

As the debate over health reform continues, see if you can tell who’s winning this particular framing-of-the-issue struggle. It might be a clue as to who’s ahead on the broader issue of health-care reform.

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Comments (11)

Good article. I think another way of looking at it is what is the #1 determinent of disability or death before age 70. It would be obesity by far with all its attendant problems. Cancer and heart disease are becoming more like chronic problems for those fortunate to recieve proper care.

I’m just going out on a limb here and suggest that we take a look at the fast-food and junk-food companies who spend a great deal of marketing money ensuring that kids become their “brand ambassadors’ for life. And that we spend a bit more time educating parents on how to keep these messages out of their kids’ lives. Covers societal factors AND personal responsibility.

Doing more to make our society less car-centric is a huge part of the solution. We have turned over so much of our public space to automobiles, arranging our society for the convenience of motorists above all else.

We have to get out of the habit of hopping in our car for trips of less than a mile. Walking and biking must be safe, easy options.

And we have to stop building neighborhoods that virtually *force* people to drive everywhere.

Not just fast food. Are there any restaurant chains left that don’t load up on fat grams?

A while back a local Thai restaurant ran a picture of how much Thai food you could eat before you’d run up as many calories as one restaurant chain’s bacon quesadillaburger. Even then the Thai food had only a fraction as many fat grams and sodium.

Commentator # 4 has it right on.
As to #5, we need to realize fat is not always the enemy (we need small amounts of all three major types for different body fundctions and nutrient assimilation), and refined foods are more culpable.

Also, If you do a tax on sodas, include diet sodas: a study a long time ago found that drinking diet soda correlated with increased caloric intake. Just why, was never explained. but it happens.

On recent trips to Japan, I’ve made a point of looking for overweight people and observing the lifestyle in general.

Remember the original “Shall We Dance,” in which the main character cycles to the train station to catch his commuter train, even though the family owns a car? That is a very typical pattern in that country. Even when traveling by public transit, people often have to transfer in labyrinthine subway stations with walks up to 900 meters (about half a mile). Workers don’t drive if they go out to lunch; they walk, sometimes several blocks. Neighborhoods contain all essential services and are walkable. Even the more car-dependent suburbs have train stations with bicycle parking areas.

Even though Japanese people can be real junk food junkies, the walking built into their days keeps the weight off.

The “Obesity Epidemic” is a cultural panic dressed up as a public health problem. Obesity is on the rise, but the figures suggesting it is an independent risk factor for illness or mortality other than joint problems are highly dubious. Susan, please consider ordering this book, or The Obesity Myth, by Paul Campos. The research linking obesity to health problems doesn’t generally control for dieting or exercise, the former being problematic and the latter being protective. Plus, as you recently noted, overweight is protective for mortality until you get to the morbidly obese.

You miss a big point here – sleep deprivation. Google obesity and sleep deprivation and you’ll see what I mean. It is highly correlated with obesity, and a number of scientific studies show why. Lack of sleep actually alters hormone production. Any implication of sleep deprivation inevitably gets into the entire structure of society.

I think the problem needs to be redefined a bit–from obesity and overweight to malnourished. Unfortunately, the American diet, high in saturated fat and refined carbohydrates, probably contributes to many health issues such rapidly increasing rates of multiple sclerosis (MS) (studies show a correlation between saturated fat consumption and MS), various cancers, heart disease, etc.

Our poor eating habits seem to me to be a far greater threat to our country than any terrorists ever have been. With the current sorry fitness level of our citizens, if we ever had a world war, who would waddle out to fight it?